Greens promising an extra $280 million a year of health spending

May 31st, 2014 at 12:10 pm by David Farrar

The Greens have announced:

The Green Party today launched a $29 million plan to improve the health of young people aged 13-17, including making GP visits free for this group.

This is on top of their promise of $100 million for health hubs in schools, $100 million for “retaining health care capacity” and $50 million for higher wages.

That’s $280 million a year just on one policy – which is basically the entire surplus gone. So are they going to raise taxes, or have us stay in deficit?

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Patients getting a say on hospitals

May 13th, 2014 at 10:00 am by David Farrar

Tony Ryall and Jo Goodhew announced:

From July, patients will have the opportunity to provide feedback and rate their experiences in hospital – a move welcomed by Health Minister Tony Ryall and Associate Health Minister Jo Goodhew.

“DHBs will be running a quarterly survey of patients to find out what they think about their most recent stay in hospital,” says Mr Ryall.

“The survey has 20 questions covering issues such as whether patients understood the advice they were given by their doctor, whether they were involved in decisions about their care and treatment, and whether they were treated with respect and dignity by hospital staff.

“Responses will be collated to give each DHB a rating out of 10 in four areas: coordination, partnership, communication, and physical and emotional needs,’ says Mr Ryall. 

Mrs Goodhew says this will be the first time this information has been collected and measured in the same way across the whole country.

“The results will help DHBs to make improvements in care and give the public valuable insights into the performance of their local health services,” says Mrs Goodhew

“The new survey, which was developed by the Health Quality and Safety Commission, will be an important way of measuring the quality of health services.

That’s a very good idea – both getting patient feedback, but also having comparable data across hospitals.

Of course that data may be used to make one of those evil league tables, so I guess some parties will be against it!

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The healthcare portal

January 15th, 2014 at 12:00 pm by David Farrar

Stuff reports:

The face of New Zealand healthcare will change before the year is out as Kiwis are signed into patient portals allowing them to self-manage their medical records, book doctor appointments and chat to their GP online.

The new multi-million dollar electronic healthcare system is a hybrid of internet banking and social networking – giving patients a secure account to view their medical records and test results, but also a private platform to instantly message their GP.

National health IT board director Graeme Osborne said the patient portal service was “ground-breaking”. It would empower Kiwis to take control of their own healthcare.

More than 50 per cent of the country’s general practices would be using the service by the end of 2014, he said.

“This is more than a hope. Each region and each district in New Zealand will roll this out.”

Online services would initially include a list of the patient’s medical conditions and medications, notifications when laboratory test results were available, the ability to book doctor appointments and order repeat prescriptions online and a messaging system to email GPs for health advice.

That would be great. I’d love being able to book appointments online and being able to access my own test results.

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Prioritise health towards the young

November 25th, 2013 at 10:00 am by David Farrar

The Herald reports:

Dr Paul Hutchison, chairman of the health committee which this week made a raft of recommendations around early intervention health programmes, told TVNZ’s Q + A the Government needed to reprioritise the health budget to better address the needs of many young New Zealanders.

“This dollar spent very early on, not only improves the health outcome of the younger, it gives them the chance to be productive and lead highly functional contributory lives.”

I agree. For the same reasons I would spend more on early childhood education than tertiary education – you do the most good when young.

They key recommendations from the select committee chaired by Dr Hutchison are:

*Research the cost-effectiveness of early intervention programmes from pre-conception to three years within 12 months.

*Set a national health target for all women to have an antenatal assessment within the first 10 weeks of pregnancy.

*Make sexual education mandatory in all schools and increase access to long-acting contraceptives.

*Develop an action plan with NGOs and private sector for evidence-based nutrition programmes.

*Develop an action plan to combat fetal alcohol syndrome, introduce warning labels on alcohol products, and consider higher taxes on alcohol.

*Consider expansion of early childhood education services in poor areas.

*Prime Minister to take on a formal leadership role in developing a cross-agency plan for children’s health.

*Invest in a nationwide oral health campaign and transfer responsibility for fluoride additives to Ministry of Health and DHBs.

*Give support to funding for research on children’s health, and match it to international benchmarks.

 All looks pretty sensible and worthwhile.

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The desirability of part-payments for healthcare

October 21st, 2013 at 4:00 pm by David Farrar

Treasury announced:

Inaugural Treasury University Challenge Winner Announced The winner of the New Zealand Treasury’s inaugural University Challenge is Sarah Shier, a Master of International Business student at the University of Auckland.

Her essay on Health and the possibility of co-payments was judged the best among entries submitted by students from all of New Zealand’s universities and from a range of disciplines. Entrants were asked to write a 2000-word essay to answer one of three questions on Crown assets, health, and overseas investment.

“The calibre of Sarah Shier’s essay and those of the other finalists was very impressive,” says Deputy Secretary for Strategy, Change & Performance Bill Moran.

“In assessing pros and cons of extending part-payments in our health system, Sarah showed both sides of arguments and brought together evidence from several sources to make her case. She also looked at how different socioeconomic groups might be affected, anticipated issues, and put forward measures to address concerns. It was high-quality work and I congratulate Sarah on her success.

“This competition has been a success for the Treasury too. We wanted to give university students a feel for the range of work the Treasury does and let them test their analytical skills on real life policy issues. We also wanted to reward excellence in public policy analysis and the University Challenge was a great chance to do this.

“After this year’s success the Treasury is looking forward to running the University Challenge again in 2014.”

Winner Sarah Shier will receive $2,500 towards her university fees for 2014.

Well done Sarah. Her essay is here. Some extracts:

Increasing co-payments for costly medications creates the opportunity to improve patient access to clinically effective medicines. Additionally, expenditures would be reduced as patients opt for preventative treatments over costly hospitalisations. Co-payment reform would also address socioeconomic and ethnic inequalities in the healthcare system by ensuring that subsidies are provided for those who need them the most.

Nonetheless, if not structured correctly, increased patient payments may exacerbate ethnic healthcare inequalities in the status quo. Furthermore, policies ought to continue subsidising preventative care in order to reduce long-run healthcare expenditures.

And on PHARMAC:

Medical professionals argue that PHARMAC’s rationing policies have limited the availability of effective medications within New Zealand. A 2008 report indicated that “New Zealand has 84 fewer innovative medicines funded than Australia.” Limited availability of blood pressure and lipid level medication can be costly in the long run as patients seek more expensive treatment for largely preventable cardiovascular conditions. Cardiovascular disorders accounted for the largest percent of “avoidable hospitalisations” within a Canterbury Hospital study.

Increasing co-payments for medications that benefit patients but are restricted in the status quo would improve the quality and efficiency of the healthcare system. Funding limitations have driven PHARMAC to fund some medications for high risk individuals only. However, expanded usage of pharmaceuticals such as statins may benefit lower risk patients and strengthen the healthcare system by preventing unnecessary costs in the long run. Co-payments could be applied to drugs such as statins that are widely beneficial but expensive to provide.

And on targeting:

Although funding for low-income healthcare has increased, a disproportionate amount of current expenditures are spent on high decile areas. Since the late 1990s, healthcare funding has increased more for higher income deciles than the more needy lower income categories.

Increased expenditures on broad initiatives—such as the community-based Primary Healthcare Strategy— have been largely responsible for the discrepancy between deciles. As a result, combined spending on decile 1-5 areas dropped to 54% in 2010.

Under a co-payment reform plan, subsidies could be targeted towards low-income groups to ensure equitable treatment. Increased patient payments could be designated for higher income individuals with the means to afford a modest increase in their current co-pay.

I believe it is sensible to target health care subsidies to those on lower incomes, and have those better off pay for a larger proportion of their own health needs.

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Patient ranking for hospitals

October 20th, 2013 at 10:24 am by David Farrar

The SST report:

Patients will be able to write reviews of their public hospital stays when Trip Advisor-style ratings are adopted in New Zealand next year.

Health Minister Tony Ryall has confirmed a patient ranking system for public hospitals, similar to those already in use in Britain, will be rolled out nationwide.

It will allow patients to score hospitals on the quality of their emergency departments and inpatient wards and comment on what they liked or disliked, including staff, beds and food.

In Britain, the National Health Service introduced the Friends and Family test in April this year. Patients are surveyed and can write online reviews, giving hospitals and clinics star ratings on cleanliness, staff co-operation, dignity and respect, patient involvement and accommodation.

In New Zealand, the Health Quality & Safety Commission is working on a similar but more comprehensive version of the tests for our hospitals.

That’s a great idea. Public ratings and feedback can be a very effective way of incentivising high standards.

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Saint Göran Hospital

May 28th, 2013 at 3:00 pm by David Farrar

The Economist reports:

SAINT GORAN’S hospital is one of the glories of the Swedish welfare state. It is also a laboratory for applying business principles to the public sector. The hospital is run by a private company, Capio, which in turn is run by a consortium of private-equity funds, including Nordic Capital and Apax Partners. The doctors and nurses are Capio employees, answerable to a boss and a board. Doctors talk enthusiastically about “the Toyota model of production” and “harnessing innovation” to cut costs.

A hospital owned by equity funds and run like a car company? The instinct would be to deplore it as everything that a hospital shouldn’t be. But what is the reality?

The hospital today is organised on the twin lean principles of “flow” and “quality”. Doctors and nurses used to keep a professional distance from each other. Now they work (and sit) together in teams. (Goran Ornung, a doctor, likens the teams to workers in Formula One pit stops.) In the old days people concentrated solely on their field of medical expertise. Now they are all responsible for suggesting operational improvements as well.

So staff are empowered.

One innovation involved buying a roll of yellow tape. Staff used to waste precious time looking for defibrillator machines and the like. Then someone suggested marking a spot on the floor with yellow tape and insisting that the machines were always kept there. Other ideas are equally low-tech. Teams use a series of magnetic dots to keep track of each patient’s progress and which beds are free. They discharge patients throughout the day rather than in one batch, so that they can easily find a taxi.

The best ideas are often simple. My staff came up with the idea of using Facebook to organise rosters. It turned what was teh most challenging part of our operations to simplicity – as it allowed staff to arrange their own replacements.

St Goran’s is the medical equivalent of a budget airline. There are four to six patients to a room. The decor is institutional. Everything is done to “maximise throughput”. The aim is to give taxpayers value for money. Hospitals should not be in the hotel business, the argument goes. St Goran’s has reduced waiting times by increasing throughput. It has also reduced each patient’s likelihood of picking up an infection. However, scrimping on hotel services means that it has to invest in preparing patients for admission and providing support after they are released.

Sounds all positive. Reduced waiting times, reduced infections, better pre and post admission support.

Sweden has gone further than any other European country in embracing the purchaser-provider split—that is, in using government money to buy public services from whichever providers, public or private, offer the best combination of price and quality. Private firms provide 20% of public hospital care in Sweden and 30% of public primary care. Both the public and private sectors are obsessed with lean management; they realise that a high-cost country such as Sweden must make the best use of its resources.

I think it is a pity the funder provider split was never fully implemented in NZ.

St Goran’s also acts as a hare for Capio, one of Europe’s largest health-care companies, with 11,000 employees across the continent and 2.9m visits from patients in 2012. Sweden is Capio’s biggest market, accounting for 48.2% of its sales (France comes second with 37.6%). The firm performs 10% of all Swedish cataract operations, and much more besides. Capio thinks it can make huge savings in other countries by transferring the lessons it has learned in Sweden. The average length of a hospital stay in Sweden is 4.5 days, compared with 5.2 days in France and 7.5 days in Germany. Sweden has 2.8 hospital beds per 1,000 citizens. France has 6.6; Germany, 8.2. Yet Swedes live slightly longer.

A great stat.

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Food stupidity from Labour

April 12th, 2013 at 1:00 pm by David Farrar

Stuff reports:

Patients could be fed week-old food under Government plans for hospitals, leaked documents have revealed.

A report obtained by TV3 News yesterday showed food would be made in two hubs, in Christchurch and Auckland, and then transported to hospitals across the country, saving $10 million.

Some of the food could be chilled for up to a week before being served. …

Labour Health spokeswoman Annette King said the move was ‘‘a shocker’’.

‘‘I’m trying to imagine what a silver beet looks like after six and half days in the chiller,’’ she said.

‘‘It can’t be good for patients to be fed food cooked and chilled for up to seven days.’’

A Health spokesperson should be more responsible that suggesting chilled food is unsafe.

Millions of NZers eat food that has been chilled and then reheated.

It really is pathetic, this type of mindless opposition.

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What do we want our health dollars spent on?

April 11th, 2013 at 12:00 pm by David Farrar

The Herald reports:

The Government is refusing to say how many jobs could be lost in a proposed overhaul of the provision of hospital meals that would save up to $175 million over 15 years.

The plan has been drawn up by Health Benefits Limited (HBL), a Government-owned organisation set up to find savings by reducing duplication and administration costs.

Health Minister Tony Ryall confirmed there would be staffing cuts and didn’t rule out closing or downsizing some of New Zealand’s 39 hospital kitchens operated by 20 district health boards.

But Mr Ryall said the quality of meals provided to patients would be paramount and not compromised by the changes.

If the DHBs can save money with more efficient meal costs, and no change in quality, then of course it should and must do it.

The purpose of the health system is to help sick people get well. Not to create jobs for kitchen workers.

The more money one can save on support services, the more money available for surgeries, drugs, cancer treatment etc.

Compass already provides a third of health board meals, Spotless Services another third, and local providers the rest.

So two thirds already contract the service out. Not surprised the DHBs have realised that one national contract could cost a lot less than 39 separate contracts.

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Elective Surgeries

August 16th, 2012 at 1:53 pm by David Farrar

Tony Ryall has announced:

“An extra 7,500 patients received elective surgery in the last 12 months, meaning 153,000 people got the operations they needed. This is the fourth year of record increases under National,” said Health Minister Tony Ryall.

“Since the change of government in 2008, thirty per cent more patients are getting elective surgery.

This is a pretty incredible achievement when you consider the fiscal environment.

It shows what you can achieve by having a more focused and efficient health system.

My only wish is Ryall goes further and defunds all the public health lobby groups which campaign for nanny state policies, and puts the money saved into elective surgery.

“In the last year the number of patients across the country waiting longer than six months has been reduced by eighty-five per cent from 5,700 to 840.

“This includes 690 patients on Canterbury DHB’s list which has been exempted from the target this year. Not counting Canterbury, this means that now only 150 patients who are booked to see a specialist or for surgery are waiting more than six months across the country at any one time.

So now only 150 people now waiting more than six months? What was the figure in 2008 I wonder?

“The challenge is now to lock in the goal of zero patients waiting over six months, and then bring the maximum waiting time down to five months by the end of June 2013,” Mr Ryall says.

No resting on the laurels.

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Prescription Charges

May 15th, 2012 at 11:00 am by David Farrar

Tracy Watkins at Stuff reports:

Prescription charges will increase from $3 an item to $5 an item in next week’s Budget, as the Government moves to offset the cost of extra health spending in the “zero Budget”.

The new charge will cover up to a maximum of 20 items from January 1 next year, raising $20m in the first year and $40m after that.

Health Minister Tony Ryall and Prime Minister John Key said the money raised would be  reinvested in the health sector.

“Despite tight financial times and what will be a zero Budget on May 24, health will receive a big funding boost, which will come from savings within health and across the Government’s accounts,” Ryall said.

It was the first time the prescription charge has been increased in 20 years. There will continue to be no charge for under-sixes.

Despite this Hone Harawira is claiming children will die because of this.  Anything for a cheap headline.

The fee used to be $15, and Labour in 2004 reduced it to $3. This increase is a maximum $40 per year per person, so I don’t think will be a huge impact for most. The Government noted:

New Zealand continues to have low prescription charges compared to almost every other developed country.

In Australia, for example, the standard prescription charge is up to NZ$45 and in England it’s around NZ$16. In Australia people on low incomes pay around NZ$7.45 per item. In Finland, there is an annual limit of around NZ$1,107 per patient, after which there is a flat fee of around NZ$2.50 per medicine item.

I think Australia has the right idea. It is hugely economically inefficient to provide subsidies to wealthy people who don’t need them. We spend just over $1 billion a year on subsidized medicines.

What Id like to see happen is that low income people with a community services card get their medicine highly subsidized (pay only $3 to $5), while others pay somewhere between most and all of the cost themselves.

The real challenge for this Government is to reduce the huge amount of middle class welfare we have.  We can support those less well off better, if we are not subsidizing medicines for millionaires.

UPDATE: The maximum possible extra cost per person family works out at 11c a day. This puts into context the hysterical claims by Harawira which the media are giving such prominence to.

So this week we have the offer of free voluntary contraception to beneficiaries being compared to Nazi war crimes by Josef Mengele, and a maximum 11c a day rise in the cost of prescriptions to killing children. Some on the left are getting rather demented.

 

 

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Smoking Targets

April 16th, 2012 at 1:00 pm by David Farrar

Labour’s Iain Lees-Galloway has said:

The Government is deliberately ignoring health data that doesn’t tell the story it wants the public to hear, Labour’s Associate Health spokesperson Iain Lees-Galloway says.

“Statistics collected by the Ministry of Health reveal that every district health board (DHB) except one is failing to get close to acceptable rates for early smoking cessation intervention.

“The Government wants us to believe it has made smoking cessation a priority. These figures highlight the reality – it hasn’t, “Iain Lees-Galloway.

“The Ministry of Health expects 90 per cent of smokers who see a GP to be provided with advice and help to quit, yet only one DHB is reaching that target.

“No other DHB is even close. In fact, on average they are underperforming by 57%.

“Tony Ryall, of course, is allergic to bad news, so these figures never get reported.

 “Interestingly he talks up statistics around smokers who end up in hospital* and the advice they get there.

“But only reporting smoking cessation activities in hospitals is ludicrous. Far more people see their GP than go to hospital.

This is an interesting issue. Lees-Galloway is taking about two seperate things – the proportion of smokers who see their GP who get advice and help to quit, and the proportion of smokers in a hospital who get advice and help to quit.

The hospital figure is the official national health target. It was 90% and has just gone up to 95%. The DHB average was 95% in the first quarter of 2011/12 and slipped back to 89% in the second quarter. Six DHBS made 95% and 12 made 90%, while eight did not.

Now hospitals are actually run by DHBs. DHBs control hospitals. A DHB has the ability to put in place policies around offering quit smoking services to patients. Also be aware that the average person spends hours or days in hospital, so it is easier to do something additional to the reason they are in hospital.

GPs are not employed by DHBs. They are private entities, that only get a portion of their income from the Government. The ability of a Government to get GPs to do something is very limited, and frankly it is silly of Lees-Galloway to think they can.

Now from what I can tell, the DHBs only started funding GPs to even code their patients as to whom are smokers and non-smokers. Sure it is recorded in notes in long-hand, but it is a big job to go through every file and mark them in the database as a smoker.

The new target for GPs only started this year, and they noted:

Unlike the other health targets, this measure started from scratch as provision of advice and help to smokers was not recorded previously nor even offered routinely.

So imagine what is involved to get every GP in NZ recording the status, and then also recording if they offered quit smoking assistance. I’ve worked in a medical centre. The average visit is around 15 minutes, and covering anything apart from the immediate problem slows things down a lot. Now this is not to say it is not a good idea – it is. But expecting 90% achievement in the first year is silly.

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Oh dear some awful income inequality

February 4th, 2012 at 10:23 am by David Farrar

Martin Johnston at NZ Herald reports:

Some Auckland surgeons are being paid more than $6000 for a day’s work at a public hospital.

My God. They are part of the 1% scum.

The Waitemata District Health Board scheme has divided doctors over concerns that the surgeons involved can earn nearly four times as much as general physicians and psychiatrists on their collective agreement’s top step.

Income inequality alert. This is evil and must be stopped.

The Waitakere “pilot” project pays orthopaedic surgeons a contract rate of $2200 for each total hip or knee replacement package of care. This comprises $1320 for the operation plus $880 for daily patient review, any call-backs during the hospital stay, availability for six weeks after surgery and a six-week visit.

A fixed cost per operation. We can’t have that.

On the union-negotiated multi-employer collective agreement, specialists of all kinds on the highest step earn an annual base salary of $206,000, or $99 an hour, but this increases to around $170 an hour when leave, KiwiSaver and allowances are factored in. Some specialists are paid above the collective’s rates.

Good God, they get paid even more than stevedores.

Senior doctors’ union executive director Ian Powell said the split rates undermined the team-work that was critical to the safety of patients in a complex public hospital.

Oh yes, because one doctor is paid more than another, they will compromise patient safety. I have to say I don’t know any doctors like that.

So why is the DHB doing this nasty income inequality with its doctors?

DHB chairman Lester Levy said the pilot had worked very well.

The rates paid to orthopaedic surgeons were around 60 per cent of private-sector rates. The scheme had led to a number of surgeons opting to do less private-sector work in favour of doing most of their work on public patients.

Productivity was up by a third. Costs shrank 12 per cent for hips and 16 per cent for knees because of a 40 per cent reduction in patients’ average length of stay in hospital, less time in theatre and fewer staff being involved in treatment.

Bringing previously out-sourced surgery in-house saved the DHB $3 million in the last financial year. Patient satisfaction was high and the transfer rate to North Shore Hospital was low.

So paying some staff more has saved the DHB money, improved productivity, reduced lengths of stays in hospitals, increased patient satisfaction and reduced the transfer rate.

But despite this, the union is against this because not all staff are paid more, only some.

Labour should be welcoming what Lester Levy is doing. Rather than contract their operations out to the private sector, the Waitemata DHB is now doing them in-house.

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Labour candidate on elective surgery

November 16th, 2011 at 11:59 am by David Farrar

The Wairarapa Times-Age reports:

Wairarapa residents have the second best access to elective surgeries in the country.

Health Minister Tony Ryall said more than $11 million had been poured into health service improvements in the region over the past three years and in that time 264 extra elective surgeries have been completed,

One would think this is a good thing, right?

Mr Ryall said performance efficiencies in Wairarapa over the past three years included more specialist appointments and shorter waiting times in emergency departments and for cancer radiation treatment.

There had been a 25 per cent increase in publicly funded chemotherapy clinics, record levels of immunisation, and improved diabetes and cardiovascular services and help for smokers to quit, he said.

Also sounds good I would have thought?

However, Wairarapa Labour candidate Michael Bott said the increases in elective surgery turnover “may not be all they seem” and that other health services in the region had been sacrificed for increased surgical funding. …

“The fact is that funding cuts have reduced the capacity of many health services. Front-line staff are doing back office work as well and everything else is getting squeezed to put more money into sexy elective surgery numbers,” Mr Bott said.

So Bott thinks elective surgery operations are “sexy’. In the dismissive context he uses it, he implies superficially attractive but not really that important.

I wonder if Mr Bott has ever been in need of surgery, and had to wait years on a waiting list? I suspect he would be less dismissive of it then.

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What a comparison

November 13th, 2011 at 10:00 am by David Farrar

Kathryn Powley in the HoS compares:

The Nats are promising to cut elective surgery waiting times from six to four months and boost the number of operations by 4000 and increase med school places.

Labour would develop “nationwide tools for elective surgery prioritisation based around timelines, equity and quality”. Hmm, concrete promises with dates, times and numbers attached, or long-term strategies, principles and vision? What’ll it be, voters?

I think this sums up the difference wonderfully. Ryall has focused on measurable important improvements, while Labour just have meaningless waffle.

The last Labour Government had dozens of strategies for the health sector. I think there was something like 50+ different goals and targets. The result was massive waiting times for operations, cancer patients flying to Australia for treatment, and huge queues in A&E.

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A contrast

November 10th, 2011 at 4:32 pm by David Farrar

Yesterday Labour launched their health policy. I don’t think I have ever come across such a waffly policy full of principles, reviews, develop systems, strengthen, align. It’s 28 pages of waffle. Almost the only specific is, well I let John Pagani reveal it:

National has flatly rejected Labour’s proposals to once again ban junk food in schools.

John comments:

That sort of policy is asking for trouble.

So good old nanny state Labour are back to their worst. No pie is safe. The food police return.

And what has Labour been up to today:

Labour’s thinly-veiled attacks on Prime Minister John Key have continued today with leader Phil Goff bringing up the subject of Hawaiian holidays.  …

“People at the top have got a lot of money and they take their holidays in Hawaii,” Goff said.

The politics of hate and envy. Because John Key has not spent the last 30 years as an MP, and actually went into business, he is one of those despicable rich pricks.

It is sad to see Phil Goff succumb to Key Derangement Syndrome. Goff generally is a decent man, but he is trashing his own reputation as he continues down this line.

Meanwhile what has National announced today? Also a health policy, on waiting times:

Ensure all patients booked for elective surgery receive it within no more than four months by the end of 2014.

Compare that to Labour’s waffle. A specific commitment, that matters to New Zealanders.

And National has a good record here. Since 2008:

  • 60,000 more patients got elective surgery than the previous three years
  • An extra 27,000 patients a year getting elective surgery – an increase of 22% since 2008
  • 91% of patients getting elective surgery within 6 months of being on the waiting list

So Labour is focused on banning pies and where John Key’s family choose to holiday, and National is announcing it will boost elective surgery by a further 4,000 operations a year and cut waiting times by a further two months.

It shows who is focused on the issues that really matter to New Zealanders. It shows why hopefully Labour is dropping in the polls and hopefully will be crushed on November 26.

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27,000 more elective operations a year

September 7th, 2011 at 12:00 pm by David Farrar

Tony Ryall announced:

A record 145,414 patients received elective surgery in the year ended July 2011 says Health Minister Tony Ryall.

Elective surgery operations include hip and other joint operations, cataracts and grommets amongst other important life improving surgeries.

“This means an extraordinary extra 27,000 patients a year are now benefiting from elective surgery compared with the numbers treated under the previous Government”, Mr Ryall says.

“Over the term of this Government, around 60,000 more elective operations have been delivered over the three years.

This would be a good achievement if it occurred during a time when the Government had massive surpluses and could throw unlimited dollars into Vote Health.

To manage to get an extra 27,000 elective operations a year during a time of our largest ever fiscal deficit, and a global recession is quite extraordinary.

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Health itches

August 30th, 2011 at 3:00 pm by David Farrar

Grant Robertson blogs at Red Alert:

The conventional wisdom is that Tony Ryall is making a good fist of the Health portfolio. Now that I am up close in the area I can say that he keeps a tight rein on matters health, and is managing the portfolio effectively.

I’m trying to recall the last time an Opposition Spokesperson said the Minister is managing the portfolio effectively. Good on Grant though for acknowledging the reality. Of course he has a criticism:

But there is a big difference between managing the politics of health and actually doing what is right for the long term health outcomes of New Zealanders.

So what does Grant mean by this:

The best evidence of that is the release today of the Child Health Monitor Report. It shows, among other things, that in the last two years there have been an additional 5 000 avoidable hospital admissions for things like respiratory illness and skin infections. The authors of the report note that the cost of going to the doctor, especially after hours is a factor in whether children are getting the healthcare they need, along with a range factors associated with child poverty.

I am not saying all of this is down to the Health policy of the current government. But the focus on the narrow range of health targets set by the Minister means that child health is not the priority it should be. The Minister has narrowed the health targets in such a way as to scratch the itches of waiting lists and time spent in ED, but it is at the expense of early intervention and public health programmes.

So what are these itches that Grant refers to? An itch suggests something that isn’t that important, but is noticeable. Well the six targets are:

  1. Shorter Stays in Emergency Departments
  2. Improved Access to Elective Surgery
  3. Shorter Waits for Cancer Treatment Radiotherapy
  4. Increased Immunisation
  5. Better Help for Smokers to Quit
  6. Better Diabetes and Cardiovascular Services

Now it might just be me, but I doubt many people would regard shorter waiting times for cancer treatment as just scratching an itch, or having more people get elective surgey or having shorter waits in ED Departments.

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Keneperu Hospital

November 9th, 2010 at 4:04 pm by David Farrar

These figures were released from Keneperu Hospital under the OIA. The left hand axis is surgical procedures which have grown a staggering 57% in just two years. The right hand axis is outpatient consultations, which have increased 30% in two years.

I think most will agree a far better trend than from 2005 to 2008.

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$3 prescription charges

July 15th, 2010 at 12:00 pm by David Farrar

The Dom Post reported:

Poorer New Zealanders are ending up in hospital because they cannot afford to pay for medicines prescribed to them, a study has found.

Maori and Pacific people are especially hard-hit and the study’s author says the only way to ensure equality is for the Government to lower co-payments – the amount patients have to pay for each prescription.

I’m not so sure. We’ll look at details in a minute, but first I’ll make the general point that even when certain health services are free, such as immunisations, they are not fully taken up.

The research, published in the international Journal of Epidemiology and Community Health, found more than six per cent of the 18,000 people surveyed had put off filling a prescription for financial reasons at least once a year.

So 94% do manage to pay the $3 charge. To me that suggests that rather than scrap the fee for everyone, you look at targeting assistance to those on the lowest incomes or greatest health needs.

Who should someone like me not pay the $3?

The other query I have, is were those 6% facing purely the $3 charge, or was there an additional part-charge for some of them as the medicine was not fully subsidised?

That figure jumped to 15 per cent for Pacific people and 14 per cent for Maori.

The results were alarming, lead researcher Santosh Jatrana said.

“We were not expecting that much difference between ethnicities.”

Maori and Pacific people not only tended to be more deprived but were also more likely to have greater health needs, Dr Jatrana said.

But they also have the lowest immunisation rates, and they are free. There may be cultural factors at play, beyond price.

It was worrying that people who had two or more illnesses – and often needed multiple prescriptions – were also avoiding picking up prescriptions, she said.

“Deferral of necessary drugs is only going to make their conditions worse.

“People who put off buying prescription drugs because of cost are more likely to be admitted to hospital with serious acute conditions as they haven’t purchased medication or gone to their GP.”

Overseas studies had shown that people who could not afford all their medication resorted to giving themselves half-doses, skipping doses or spending less on basic needs such as electricity or food.

There was a clear message from the study, Dr Jatrana said. “We need to reduce the co-payments. It’s very simple and straightforward.”

Not at all. Someone has to pay for all these drugs. If 94% of people are paying without problem, why would you stop charging them?

Target the people most in need I say.

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Editorials 18 June 2010

June 18th, 2010 at 9:09 am by David Farrar

The Herald looks for details around the foreshore law:

Unease has been generated by Attorney-General Chris Finlayson’s statement that customary title is “an ownership title”.

This creates a considerable breach with the existing 2004 legislation, which vested the foreshore and seabed in the Crown.

Iwi and hapu whose claims succeed will receive a deed giving title to a coastal area.

They will not be able to sell the property or block public access, but they will have considerable control, including the ability to veto or initiate development, permit activities, and exploit non-nationalised minerals.

He says the compromise reached between the Government, the Maori Party and the Iwi Leadership Group means that, from the staging post of the public domain, there will be few awards of customary title by the courts or as a result of negotiation with the Crown.

That, says John Key, is because the threshold for the granting of such title is high.

Iwi and hapu applicants will have to show continuous and exclusive occupation of the area claimed since 1840.

A test the Court of Appeal said would be hard to meet.

The Dom Post focuses on health issues:

Decisions on health spending are among the most difficult of all those that governments face. They can literally be a matter of life and death.

There are no easy options. Though the public purse is not bottomless, the demand for health services is. There is always a new drug that can be bought or an extra treatment that can be added, always a demand for extra dollars to be spent.

In health, the issue is always where the line is to be drawn, the line that divides patients between those who get to have the state pick up the bill and those who are told that their health needs are their fiscal responsibility.

The line being debated at the moment is who should get bariatric surgery and who should not. The operation costs between $17,000 and $35,000, but has been shown to have dramatic effects on the morbidly obese, with patients halving their weight and with weight-related health problems vanishing along with the kilos.

There are those who will say that the obese have brought it on themselves, and because of that should not be a priority for health spending.

That is not an approach that is applied elsewhere in the health system. Smokers are not told their lung cancer will not be treated because they knew the risks and continued to smoke anyway. Those who spent their summers acquiring a deep mahogany tan are not told that the skin cancer that resulted will be left untreated. And drunk drivers and the thousands of others who injure themselves because they drank too much are not turned away from the hospital doors because they made the wrong choices.

But maybe they should be, to some degree. If you protect people from the consequences of their choices, then they may continue to make bad choices.

If a smoker is told their health insurance premiums will be an extra $1,500 a year because they smoke, that could result in many quitting.

The Press drills into the oil spill:

For BP, the scale of the disaster is such that it looks as though it will bring about the end of the company in its present form. Some estimates suggest that the rapidly mounting costs for the company from the fines and damages it will have to pay could reach $40 billion. Even for a company with annual sales of a quarter of a trillion dollars and profits last year of $17 billion, that is a huge sum to absorb. Already BP has lost half of its value on the sharemarket (incidentally hitting pension funds hard) and it is possible it will have to file for bankruptcy protection and reorganise itself in order to survive. Yesterday it cancelled its dividend (further hitting pensioners and others who are invested in it) in order to pay for a $20 billion fund to meet its present estimated liabilities. The costs are clearly going to spread far beyond the Gulf of Mexico.

The environmental scope of the disaster will not be known for some time. But if the Exxon Valdez could be described as the worst oil-spill disaster in the world, then this one is catastrophically larger. Exxon Valdez was in a remote, sparsely populated part of the world and while wildlife was devastated, the human impact was small. The Gulf of Mexico is just as rich in wildlife and is also, of course, heavily populated. Those people are now seeing their livelihoods, resorts and living areas destroyed.

They have been infuriated by what they saw as a somewhat insouciant response to the calamity by President Barack Obama. It was not helped by a speech he made on Wednesday, which although it gave a pledge that BP would be made to pay for all the damage it was responsible for, also told Americans a truth they have been unwilling to hear – that part of the problem is their addiction to oil-based fuels.

But the president is correct and his remarks apply as much to New Zealanders and others as they do to Americans. Consumers’ continuing addiction to oil have driven prospecting companies to take ever greater risks to meet that continuing demand. The demand itself remains high because those risks are not factored into the price they pay for petrol and other oil products. The Gulf of Mexico disaster emphatically shows that that cannot continue. Markets are already adjusting to this new reality. Consumers will have to do so too.

As oil becomes more expensive, other technologies will become more viable.

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Sensible use of the private sector

April 8th, 2010 at 4:00 pm by David Farrar

The Dom Post reports:

About 250 Wellington patients will have their operations in private hospitals after district health boards decided they could not meet Health Ministry elective surgery targets without help.

Hutt District Health Board is negotiating with Boulcott Hospital to perform about 50 mostly ear, nose and throat operations, while Capital & Coast District Health Board has asked private hospitals to carry out 200 cataract operations.

Hutt chief executive Michael Hundleby said the board turned to Boulcott Hospital because it was concerned that Wellington Hospital – which does 40 per cent of Hutt DHB’s surgery – did not have the capacity to complete the operations.

Some on the left will cry out that this is privatisation. I suppose they would rather those patients simply remain on the waiting list rather than have the private sector provide the operation. Who cares about quality of life so long as we are ideologically pure eh.

Health Minister Tony Ryall said he was not concerned that DHBs were using the private sector to help them meet the health targets, which were introduced last year.

“Our priority is that patients are treated and in the Wellington region we’ve had a record total of 11,232 patients getting the elective surgery they need.”

Great.

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Headline vs Reality

April 6th, 2010 at 6:07 am by David Farrar

The NZ Herald has a story with this headline and opening paragraph:

Lack of Govt cash kills family-health

One of the groups planning an overhaul of primary healthcare services has given up on creating “integrated family heath centres” because the Government is offering no money to help set them up.

So both the headline and the opening paragraph entirely blame the lack of money from the Government.

But for those who actually wade through the story, you find this nugget:

This bid, by the Greater Auckland Integrated Health Network, initially proposed creating up to 12 integrated family health centres. But in its formal business case to the ministry, the network has now quit that concept in favour of a simpler structure involving three “community health hubs”, after GPs rejected the earlier model.

So it was GPs who rejected the earlier model. Are they blaming it on Government cash:

The network’s spokeswoman, Professor Cindy Farquhar, said, when asked if GPs were concerned by the absence of Government funding for integrated family health centres, “Yes, that was a bit of a challenge. In this proposal there is no new money.”

So the media actually put forward the proposition that it is all about lack of money, and the GP spokesperson merely said “Yes, that was a bit of a challenge”.

General practices are mainly private businesses and the Government has no power to force them to create new types of clinics. It has put up $6 million this financial year, but only to manage the change, not to finance new or altered facilities.

So there is funding for transition costs.

Professor Farquhar said the Auckland network rejected integrated family health centres because they would duplicate existing services.

And finally we get the real reason they GPs voted to go with a modified approach.

Now I am not saying that money is not a factor at all, but the headline and opening paragraph (which is all many people read) give a quite false impression of what led to the decision.

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Elective Surgery

March 29th, 2010 at 9:59 am by David Farrar

The Herald reports:

The Government has delivered a record increase in the number of people who received elective surgery.

Last year, 134,763 patients got elective surgery funded by district health boards, which is in excess of 12,000 more than the number treated in 2008.

That’s a 10% increase, which is a hell of a lot.

The performance far exceeds National’s goal, which was an increase of 4000 a year.

Some of the biggest increases were at Waikato DHB (17 per cent), and in the Auckland region, where the Auckland DHB achieved 12 per cent and Counties Manukau 13 per cent. …

And the proportion of elective surgery the DHB contracts to the private sector remained stable last year at about 12 per cent.

This could be a lesson that there is a big difference between spending and effective spending.  Tony Ryall is obviously managing the latter.

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Compulsory Medical Insurance

March 25th, 2010 at 1:01 am by David Farrar

One of the things that many may not realise around Obama’s Healthcare Reform, is that it does not in fact create a public health system. To increase health insurance coverage, it has made it illegal not to have health insurance, with limited exceptions such as hardship or religious belief.

If a Republican President had tried to make private health insurance compulsory, I suspect the left would have decried the reform, instead of supported it. And i guess the right would have supported it, instead of opposed it.

13 states have filed lawsuits claiming it is unconstitutional to force people to take our private health insurance. I suspect this issue will get to the Supreme Court, and you do have to think there is a reasonable chance that may breach the Bill of Rights.

What I find ironic, is that Obama’s reforms have now made the US system almost the polar opposite of the Canadian system.

You see in Canada, it is illegal in some provinces to even have private health insurance. And federally there are laws that forbid hospitals from charging private rates (even if a private clinic).

So effectively in Canada it is illegal to have private health insurance, and now in the US it will effectively be illegal NOT to have private health insurance.

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